Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1113-1119 (doi:10.1542/peds.2006-1865)
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ARTICLE

Laboratory Values for Children With Newly Diagnosed Inflammatory Bowel Disease

David R. Mack, MDa, Christine Langton, MSW, MPHb, James Markowitz, MDc, Neal LeLeiko, MD, PhDd, Anne Griffiths, MDe, Athos Bousvaros, MDf, Jonathan Evans, MDg, Subra Kugathasan, MDh, Anthony Otley, MDi, Mariann Pfefferkorn, MDj, Joel Rosh, MDk, Adam Mezoff, MDl, Susan Moyer, MDm, Maria Oliva-Hemker, MDn, Robert Rothbaum, MDo, Robert Wyllie, MDp, J. Fernando delRosario, MDq, David Keljo, MD, PhDr, Trudy Lerer, MSb, Jeffrey Hyams, MDb for the Pediatric Inflammatory Bowel Disease Collaborative Research Group

a Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
b Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
c Department of Pediatrics, North Shore-Long Island Jewish Health System, New Hyde Park, New York
d Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island
e Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
f Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts
g Department of Pediatrics, Nemours Children's Clinic, Jacksonville, Florida
h Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
i Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
j Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana
k Department of Pediatrics, Morristown Memorial Hospital, Morristown, New Jersey
l Department of Pediatrics, Children's Medical Center, Dayton, Ohio
m Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio
n Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
o Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri
p Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio
q Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware
r Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

OBJECTIVE. The goal was to determine how often common laboratory tests yield normal results at the time of diagnosis for children with inflammatory bowel disease.

METHODS. Data were obtained from a registry of children with newly diagnosed inflammatory bowel disease who were enrolled prospectively in 18 US/Canadian centers. Laboratory values investigated included hemoglobin level, platelet count, albumin level, and erythrocyte sedimentation rate. Disease severity was categorized by physician global assessment.

RESULTS. A total of 526 children (mean age: 11.6 years; 58% male; 392 with Crohn disease and 134 with ulcerative colitis) were studied. All 4 values were normal for 21% of patients with mild Crohn disease and 54% with mild ulcerative colitis. In contrast, only 3.8% of children with moderate/severe Crohn disease and 4.3% with moderate/severe ulcerative colitis had normal results for all 4 tests. The erythrocyte sedimentation rate was least likely to be normal; overall, 26% of patients with inflammatory bowel disease had a normal erythrocyte sedimentation rate, including 18% with moderate/severe disease. Hemoglobin levels were normal for 32%, platelet counts for 50%, and albumin levels for 60%. There was no clear association between Crohn disease location and either severity or number of normal laboratory values. In contrast, there were direct correlations between ulcerative colitis disease severity and both the extent of bowel inflammation and the number of abnormal laboratory tests.

CONCLUSION. The presence of normal screening laboratory studies should not dissuade clinicians from considering a diagnosis of inflammatory bowel disease.

Key Words: Crohn disease • ulcerative colitis • hemoglobin • albumin • erythrocyte sedimentation rate • platelets

Abbreviations: IBD—inflammatory bowel disease • CRP—C-reactive protein • ESR—erythrocyte sedimentation rate • PGA—physician global assessment • CD—Crohn disease • UC—ulcerative colitis

Accepted Jan 31, 2007.




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